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유리 피판술을 이용한 수부 연부조직 재건술 - 100례 임상분석 - : 100례 임상분석 Analysis of 100 Consecutive Cases
한흥수 인제대학교 1992 仁濟醫學 Vol.13 No.3
여러 원인들에 의한 수부의 연부조직 결손을 각종 유리피판 이식술로서 재건한 95명의 환자, 100례를 대상으로 손상 원인 및 손상 부위에 따라 재건에 사용한 피판를 분류하고 이들의 장단점을 고찰하여 부위별로 가장 적합한 피판을 제시하였다. 성공율은 96%였으며 주로 사용한 피판은 서혜부(groin flap), 견갑부(scapular flap), 외측 상박부(lateral arm flap), 측두부 근막(temporal fascia flap)순이었다. Author reviewed 100 cases of free flaps performed between Sept. 1985 and Feb. 1992 in 95 patients who had soft tissue defects of the hand and wrist. The ages ranged from 10 to 62 years. There were 86 male and 9 female. The most frequent cause was crushing injury as 42(44.2%) patients. Thirteen type of free vascularized cutaneous, myocutaneous, muscular, fasciocutaneous, fascial, sensate tissue transfers were used. Groin free flap was the most frequently performed tissue transfer. The overall success rate was 96%. In my experience, for defects in thumb, wrap around free flap was the choice of free flap, but in other fingers, parietotemporal fascial flap with skin graft, and in dorsum of the hand, dorsalis pedis or parietotemporal fascial free flap were good. For reconstruction of first web space defects, lateral arm free flap, and for stump coverage, groin or scapular free flap were suitable. In-step free flap was recommened for reconstruction of palmar defects. Free tissue transfers provided a very reliable method for dealing with difficult reconstructive problems in soft tissue defects of the hand and wrist.
김수신,김우경,백세민,한흥수 大韓成形外科學會 1989 Archives of Plastic Surgery Vol.16 No.2
Treatment of degloving injury of parts of hand has been one of the difficult problems in hand surgery. Various methods have been applied on the treatment for its unique property. We can classify the methods of treatment into two categories. One is amputation and the other is resurfacing. Due to the fact that most degloving injuries involve mainly the loss of skin and subcutaneous tissue and underlying structures are remained intact, the injured parts can be salvaged when appropriately resurfaced. In Korea, by the Confucian influence, keeping the body intact is an important filial duty. Therefore, there are a great deal of preserve and demands from the traditional perception and from the patient to preserve anything and reattach all that is detached. By so doing, amputation of degloved part is undesirable. The resurfacing is our first goal to obtain maximum functioanl and cosmetic restoration. We use various flaps and microsurgical techniques for the surgical resurfacing. Recently, with the refinement of microsurgical techniques, reattachment surgery using microvascular techniques was performed by many surgeons. Authors report an analysis of 20 cases of completely devascularized degloving injuries of hands which were treated at Guro Hospital, Korea University from September of 1983 to August of 1987. The results are summarized as follows: 1. Fifty percent of the patients were in the age group of 20-30 years and ninty-five percent of the patients were male. 2. Roller accident was the main cause of the injury in 75%. 3. In comparison with other treatment methods, it is represented for the revascularization of the degloved-amputated part using microsurgical technique as the best result aesthetically and functionally. In conclusion, we strongly suggest the reattachment surgery using microsurgical revascularization.
한흥수,김우경,김수신,백세민 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.1
Recently, soft tissue expansion technique using tissue expanders has become a popular method for reconstruction of soft tissue defect because it provides high quality tissue with similar color, texture and hair bearing characteristics without significant donor site problems. During the period September, 1983 to December, 1988, we used tissue expanders to treat 36 patients with soft tissue defect, 3 scalp, 10 face, 6 neck, 4 trunk, 10 upper extremity, 3 lower extremity and evaluated the operative techniques, results and complications as follows. 1. We achieved favorable results in 31 cases(86.1%), especially in scalp, face and upper extremity, but poor results in lower extremity, especially below knee in location. 2. We experienced major complications in 2 cases(5.6%) such as implant exposure and minor complications in 7 cases(19.4%) such as hematoma, partial necrosis, infection, underlying bony depression etc. 3. Capsular excision is not desirable, but capsular release may permitted to acquire maximal length of the advancing flap. 4. In case of microtia, expanded tissue which was obtained from expanders is defficient for elevation of framework without skin graft. 5. Accurate and meticulous preoperative evaluation is the most important factor in achieving good and results.
한흥수 인제대학교 1991 仁濟醫學 Vol.12 No.3
수지첨부, 즉 수지 동맥궁의 말단부에서 완전 절단된 환자 12명, 13수지를 대상으로 정맥 복원없이 동맥만을 복원하고 실혈요법으로 처치한 결과 10명, 11수지(84.6%)에서 재접합에 성공하였다. 기존 치료방법과 비교해 볼 때 비록 수혈, 입원연장, 재접합 부위의 위축 등이 있을 수 있으나 수지길이 및 손톱이 보존될 뿐 아니라 감각도 거의 정상범위 내로 회복되어 기능적으로나 미용적으로 매우 우수한 결과를 보여주었다. Microsurgical replantation has been attempted in distal to digital arterial arch(Zone I). There were 12 patients with 13 amputated digits. The patients' ages ranged from 5 to 38 years old. In all cases, amputated parts were replanted with one arterial anastomosis without suture of a vein. With heparinization venous hemorrhage continued for three to ten days. Eleven of the thirteen replants succeeded. Average amount of transfusion was 2.8 pints. Static two point discrimination averaged 5.7mm and atrophic change were developed in five cases. All replanted digit preserve the nail, maintains digit length, are cosmetically pleasing and the patients are satisfied.
지속적인 直流電場이 백서의 임의형 皮版生存에 미치는 影響
유영준,한흥수 인제대학교 1993 仁濟醫學 Vol.14 No.3
백서의 임의형 피판에 지속적인 자장을 형성시킨 결과 대조군에 비해 평균 19.4%의 피판 생존율의 증가를 보였다. The effect upon the survival of skin flaps of direct current(D.C.) electric fields ware studied on the back of the Sparque-Dawley rats in this study. Twenty rats were divided into two groups-ten rats in control group and ten in electrically stimulated group. Skin flap(2×8cm; width×length) was made on the back of each rat. In electrically stimulated group, disk button battery(1.5 volt) and cupper electrodes were implanted near the flap and continious electric field of 0.9 mA was obtained. In control group, no electric field was made with disconnection of battery and cupper wires. The area of survived flap were measured in 5th post-operative day and compared with each group. The results was as 19.4% increase in the survived area of the flap in the electrically stimulated group.